Post-traumatic stress disorder (PTSD) can occur after any event that’s considered traumatizing, from a car accident to a heart attack to a combat experience. It can happen either to the person directly involved in the trauma or to others who have witnessed or been affected by that trauma.
For example, soldiers in a combat unit don’t need to be in a firefight to have PTSD from an incident, says Steven Levine, MD, a board-certified psychiatrist in Princeton, New Jersey. They can develop the condition as a result of losing their comrades-in-arms. It’s also possible to develop PTSD months or even more than a year after a traumatic event, he adds.
How PTSD is diagnosed
PTSD is diagnosed by examining symptoms that last longer than one month and cause disruption to the person experiencing them. These symptoms can include:
- Flashbacks or upsetting memories of the event
- Avoiding anything that reminds you of the trauma, including people and places, or even talking about it
- Feeling consistently sad, disconnected, irritable or without hope
- Being hypervigilant or "on guard" all the time
Those with PTSD tend to feel in danger, Dr. Levine says, as if the trauma is still occurring. When that happens, the elevated “fight or flight” response in the short term can cause psychological distress and physical symptoms, such as trembling or stomach pain. Over a longer period the sustained, elevated stress can lead to anxiety, depression, digestive issues and cardiovascular troubles, among other health problems.
“Particularly difficult is that people with PTSD tend to avoid being social, and actively push people away,” says Levine. “At the same time, having a good support network is one of the best ways to start working past the trauma.”
In addition to building a more robust social circle, there are treatments that have been shown to help those with PTSD.
Talk therapy
Speaking with a therapist, psychologist, psychiatrist or other mental health professional trained in PTSD issues is considered the mainstay of treatment, Levine says. Although medications may be recommended based on an individual’s needs, the first-line treatment is typically talking through the traumatic events and detailing their emotional, mental and physical effects. Those physical effects, which can include migraines and cardiovascular problems, will often have to be addressed separately with a healthcare provider.
Common types of talk therapy for PTSD include the following:
Cognitive behavioral therapy (CBT): Widely used by mental health professionals, CBT creates a structured approach that focuses on making behavioral changes. These may include putting strategies in place to cope with grief, identifying triggers, managing symptoms as they occur and implementing tactics to reduce stress.
Prolonged exposure therapy: Reliving a traumatic experience on a continual basis can feel overwhelming—and many with PTSD want to avoid those memories completely. A type of CBT known as prolonged exposure therapy attempts to create a safe space to allow that to happen in a way that’s constructive, Levine says. A session could involve a person with PTSD re-telling the experience several times, trying to add more detail with each fresh version, or following a guided prompt to write about the experience repeatedly.
“Usually, talking about the trauma in a non-safe space can be very triggering and make symptoms worse,” says Levine. “The goal of exposure therapy is to allow the person to share that trauma and those memories in a way that makes the experience eventually feel more emotionally neutral.”
Eye movement desensitization and reprocessing (EMDR): During another type of talk therapy called EMDR, you focus on memories of a traumatizing experience while a therapist directs your attention toward unrelated movements or sounds on either side of you within the room. The idea is that the distraction allows you to process the memory with less psychological distress, ultimately easing PTSD symptoms and helping you to heal.
Anti-anxiety medication
People with PTSD may be prescribed medications to treat depression and anxiety, or to address individual symptoms such as sleeplessness. Usually, this is in addition to talk therapy rather than a replacement for it, Levine explains. A mental health professional uses medication as a tool in the treatment of PTSD, he says, and not as a cure. Together, you can find the best medication or combination of drugs for you.
In general, treatment can take time, especially when the trauma has been life-threatening, Levine says. But making a commitment to treatment can be helpful for learning how to handle symptoms and navigate through PTSD.
To find the right therapist for you, ask your primary care physician for a referral or get in touch with professional organizations like the American Psychological Association, which can help direct you to someone in your area. Military veterans and active servicemen and women can reach out to the Department of Veterans Affairs or visit the department online for information.
